Disentangle LLC

Primary specialty

Other TechnicianTaxonomy code 247200000X

Legal business name

DISENTANGLE LLC

Practice address

11104 S Kedzie Ave
Chicago, IL 60655-2330

Phone

(708) 581-6487

NPI assigned

Mar 27, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jaclyn O'Connell

Title

Owner

Phone

(708) 581-6487

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1490572800000",
    "number": "1134650484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11104 S KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606552330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11104 S KEDZIE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606552330",
            "telephone_number": "708-581-6487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISENTANGLE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-27",
        "last_updated": "2017-03-27",
        "status": "A",
        "authorized_official_last_name": "O'CONNELL",
        "authorized_official_first_name": "JACLYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-581-6487"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Other Technician in Chicago, IL
• Providers in Chicago, IL by specialty
• Other Technician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.